UNITED NATIONS NATIONS UNIES WORLD HEALTH ORGANIZATION FIFTH WORLD HEALTH ASSEMBLY ORGANISATION MONDIALE DE LA SANTÉ A5/Technical Discussion/11 1 1 May 1952 ORIGINAL} ENGLISH Methodology of Health Protection for Local Areas AESTRACT OF REPORT ON GREAT ERITAIN Health protection is considered under 6 heads% Environmental services. School health services plus health education. Industrial health service. Local health authority services. General medical, dental, pharmaceutical, and supplementary ophthalmic services. Hospital and specialist services. 2.01 Local areas in England and Wales consist of 83 large towns and 61 administrative counties.' Population ranges from 20,000 to-2,268,000 in administrative counties.. "»» 48,000 to 1,112,000 in large towns (county boroughs). The size of administrative counties ranges from 100 to 2,500 sq.miles. " " 11 county boroughs ranges from 4 to 80 sq.miles. The total population of England and Wales is 43,745,000.
2.02 Types of services rendered arej Environmental! School health. Health education. Industrial health services Medical care: Control of communicable diseases. Sewage disposal. Refuse disposal. Water and food control. Port health. Prevention of atmospheric pollution. 24 full-time inspectors. 1,800 part-time medical officers. Some full-time medical officers. 4,000 nurses. Local health authority services; preventive medicine immunization home nursing health centres midwifery. General medical, dental, pharmaceutical, and ophthalmic services (organized by 138 Executive Councils). Hospital and specialist services (14 regions) including mental health and laboratory services. There are 500,000 hospital beds. 2.03 The entire population is served. 2.05 There arej 9,500 full-time and 11,500 part-time medical officers ).,..,. *, 00»» ea > ^cltïïvses. 5,500»»» 1,100»» midwives ) F 17,500 medical officers ).,...,,. _ ^ X - a. ' л. л xn contract with Executive Councils. 9,000 dentists ) 7,500 midwives ) 7,500 nurses (60% part-time) ) employed by local authorities. 6,000 health visitors (70% part-time) ) 1,000 medical officers ) 2,500 nurses ) 700 dentists ) in the school health services. 700 dental attendants ) 200 other attendants )
It is difficult to compare incomes because of the very variable earnings of general practitioners. 2.06 The total cost is 10. 5«0. ($29) per head per annum. 2.07 The various parts of the services interlock. Medical care is supervised centrally by the chief medical officer and principal dental officer of the Ministry of Health and their staffs. The chief public health services are now supervised by the Ministry of Housing and Local Government. 2.08 Services are financed out of? National revenue Local rates the National Insurance Fund of 40 million per annum. environmental ) services are financed from local rates School health ), _,,,,,,., [ and Government grants. Local health authority ). ь Industrial medical services are privately financed, except the super v" scr-r part (Ministry of Labour and National Service). Hospital and specialist ) services are financed by the General medical, dental, etc. ) Government. Local Health Unit (Urban) 3.OI, 3.02 3.03 Birmingham City had a population of 1,112,340 in 1951 and an area of 80 sq.miles» Communication is by railways, trams, and buses. 3.04 Services includes Hccpitals (general, isolation, maternity, mental, tuberculosis, dental) - total beds 14,699-
Maternal and Child Health! School healths (antenatal (domiciliary confinements (plus analgesia) (emergency obstetric service (postnatal (dental treatment (infant welfare (health visiting (day nurseries (home for unmarried mothers inspections school meals and milk special schools for the s (subnormal (1,975 day places +) ( 820 residential. ) Home nursing (16,000 cases attended per year). Vaccination and immunization against diphtheria. Ambulance service (99 vehicles) (physically handicappe< (diabetic (delicate (maladjusted Domestic help service (104 full-time and 210 part-time)s After-cares Mental healths Sanitary inspection. Housing. Health education: convalescent homes (603 cases) (obstetric cases (illness of housewife (elderly living alone (pulmonary tuberculosis tuberculosis i (visits by nurse (BCG for contacts (sheltered workshop (rehousing (milk hygiene extra-institutional care of mentally defective and psychotic. (individual instruction (talks (displays (films.
Personnel includes 38 full-time and 50 part-time medical officers 167» " " 46»» nurses 698»». nursing auxiliaries. 140 " " midwives 140 health visitors 64 sanitary inspectors 9 dental officers The total number is 2,638 full-time and 112 part-time. The cost of services has risen from 514,563 in 1946-47 to 1,073>159 (nearly $ 3 million) in 1950-51 (mainly because of the National Health Service Act). In 1950-51 616,000 was chargeable to local rates and the rest to Government. The entire population is served. Births and deaths are registered} 99.9$ of deaths are certified by physicians. Communicable diseases are notifiable. Morbidity statistics exist in the form of a weekly summary of claims for sickness benefit. Progress since 1930 includes introduction of postnatal clinics, home care of premature infants, day nurseries, a milk bank, an immunization scheme, and a scheme for care of aged and chronic sick. There is close co-operation with the Regional Hospital Board and with voluntary agencies, such as the British Red Cross Society, the St. John's Ambulance Society and the Women's Voluntary Service. Local Health Unit (Rural) The County of Ayr as a unit has existed since 1929, but in 1947 its hospitals were transferred to a Regional Board.
3.02, 3.03 The population was 238,000 in 1951, and the area 1,132 sq.miles. Communication is by buses and rail. 3.04 5 Services includes -.'»..; Г. Maternal and, Child Healths (antenatal domiciliary confinements postnr tal child welfare residential nursery (for debilitated children with mother unmarried or working). School healths periodical health examinations treatment of minor ailments ophthalmic and audiometric service education of the handicapped (12 resident children) dental treatment milk and meals. Health visiting and nursing. Domestic help. Sanitation. Health education. Vaccination and immunization (diphtheria and pertussis). 3.05 Personnel includes 115 full-time I! and dentists 5 part-time medical officers 75 I nurse-midwives 8 I health visitors (qualified nurses) 18 II nursing auxiliaries 32 I sanitary inspectors. The total is 347 (185 part-time, of which 180 are domestic helpers). 3.06 Because hospitals were taken over by the Regional Board, expenditure fell from 374,000 in 1946-47 to 140,000 ( 400,000) in 1950-51. Government grants cover 60% of school medical expenditure, and from 50 to 100$ of minor items.
3«07 All population is served. 3.08 Births, stillbirths, and deaths are registered. Causes of death are analysed. 100$ of deaths are certified by a physician. 3.09 Progress is difficult to assess, but an index of public appreciation is that 80$ of all children have been voluntarily immunized against diphtheria. ЗЛО A co-ordinating committee ensures ao-operation with the Executive Council and the Hospital Board.